Expert: Libby Bonner - 9/12/2008

Question
My brother is 26 years old, lives at home with my parents, and was diagnosed with bipolar disorder a year ago. He has left the house maybe ten times in the last year and half. He takes his medicine but not on a regular basis and refuses to go to therapy once a week. There has on numerous occasions been ultimatums but they all resorted into him hurting himself or threatening suicide, so we had no choice but to back down.
Because of the stress and my brother's outbursts, my little sister moved out and is living with my grandmother. My family has become afraid of what to do or what to say to him because of his irritability and overreactions to suggestions that he should find a job, move out, get help... basically anything that would take him away from playing his video games 24/7 or sleeping seemed an outrageous suggestion.
I am don't know what to do or how to help out my family. I need to do something because I watched my family be torn apart because they don't know what to do or who to turn to for help.
I just would like some suggestions on how to go about getting my brother the help he needs to be a functioning human being.

Answer
PS - I am adding this after my main answer, below.  Was your brother at home at the time he was diagnosed and began getting medicine?  If so, who got him to get care at that time?  Any way for that to happen again???    --  Also, pls let your family know that he has likely been sick for several years, and that pretty much all of the 'bad' behavior that probably occured in the yrs prior to diagnosis was because he was sick.
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Do your parents understand that he is very sick, that he has very little control over himself right now?

Ultimatums are NOT the way to go.  To get some calm in the family until he gets real help, the family should not react strongly to any of his talk, shouldn't argue w/ wild ideas, shouldn't agree or disagree w/ them.   "Hmmmm" is sometimes a good answer just to let the person know you have heard and are thinking about what he has said.

They can certainly answer 'real' yes/no questions, like when's dinner.

They MUST buy this book:  author is Woolis; title is When someone you love has a mental illness.  It will calm down the household considerably and make them not so anxious and scared and angry.  The book also discusses setting limits, which has to be done pretty carefully w/ someone unmedicated.

They, and you, need to start going to a NAMI group.  Find one at nami.org   They can find a group there, and can also email the state office to find out when there will be a Family to Family class near them, near you.  The list at the site isn't always up to date.  [The site will also give info on mental illnesses.]

Someone can also get a copy of the 2006 [?] [latest] edition of the Amador book called I am not sick; I don't need help.  It includes a method of 'befriending" the person, but also covers committals.....which are not easy to get.

The only reason a person will get admitted to a hospital these days, or picked up by police and taken there, is that they are "a danger to themselves or others."  If they live in a small town, they could talk w/ the police or sheriff about this.....but there are likely no psychiatric units in near-by hospitals.

It will be a great advantage if they are near a larger place or near a medical school, where there may be more psychiatric services.

Also check psychlaws.com [.org?] to see if your state permits "assisted outpatient treatment."

Make sure they BUY the Woolis book.  They will use it again and again.  And they must go to NAMI, where families are dealing w/ things like this and understand the problems.

This is still not going to be easy.  He is not a minor, and legally can refuse treatment.  It sounds like he is usually more depressed than "high," in the bipolar sense, and so has not directed violent behavior toward the family.

Write again after Woolis and NAMI are in the picture, or if you already have more questions.